"In the beginning..." My birth plan

The beginning is the most important part of the work.

Plato (BC 427-BC 347) Greek philosopher.

Today my blog is dedicated to a friend who wrote the following message:

Hi leila.
Was reading your blog, very useful:) I'm 24 weeks preggies, looking forward to my little guy/girl. Please detail your labour, I would really like to know what I can do to prep for it, etc. And discuss your own experience, did u use a midwife, where u gave birth, what u did for pain relief, did you tear, how can you prevent tearing, would you recommend a midwife, etc. Would really like to learn all I can:))

So in reply as promised, even though I did say I didn't wanna write about it...

Dear anonymous friend :)


The following story is mine. Each and every step detailed was taken by me, because of who I am, because of my beliefs and what knowledge has come to me by the grace of God. Your story is your own, and the choices you make will depend on your life story, please don't let mine influence yours and don't ever let someone else's make you feel as though you should have done differently. I hope that by sharing with you, all I do is illustrate that there is much more to your birth than you are led to believe, and that every step is yours to choose, as long as you are equipped with the right knowledge. So without further ado here is...

MY BIRTH PLAN

(They call it a birth "plan", because like all plans, its completely hypothetical and very rarely has much to do with reality) The first thing I did was think about what I wanted in the following salient points, in no particular order:

• WHICH HOSPITAL
• WHICH OB GYN
• DID I WANT A MIDWIFE, IF SO WHO
  
• DID I NEED ANTENATAL CLASSES, IF SO WHO
• WHAT KIND OF BIRTH
• WHICH INTERVENTIONS
• WHAT KIND OF PAIN RELIEF
• WHO WOULD BE WITH ME
  

I started, like most people do, with a gynae. As a GP myself, I know its the first thing you suggest to a newly pregnant mum. I now know that this is completely the upside down order of things. Nevertheless, I had an excellent gynae, Dr Elmarie Basson. She works from City Park hospital, and I was quite happy with traveling to town to deliver. We saw her for most antenatal visits and I loved her. I already knew that I didn't want a C-section, which everyone seemed  to be very surprised about. Apparently medical professionals historically prefer Caesarians (horror of horrors, though who am I to judge) because they've seen what natural birth does to a woman. I've seen what an operation does to a woman too, and I'm still sure I chose the path of lesser evil. Seeing the intense pain and difficulty moms have to endure after Caesars, just makes me more sure. I'm also a au naturale kinda doctor and in my mind the 'rite of passage' is beneficial in more ways than simply the randomised-trialed-scientifically-proven kind.

I also knew I wanted to give birth in a hospital. As much as I believe in the will of God, I believe that we have to be as prepared as we can. My lounge just didn't feel like the place I could be prepared. Ideally I would have liked to have all the women in my family present, but that number of women talking about the intimate details of my birth for years later scared me a little. The people who finally won the toss was of course my mother (who already had experience in happily delivering 3 children in exactly the way I wanted... quick and easy) and my dear husband (who was mostly chosen because he would have cried if I didn't choose him). To be honest I truly believed that he would faint in the first few minutes, before actually getting a chance to say something useful like "Are you a man or mouse?!" or "Pain is your friend!".

Things took an odd turn when we started talking to my gynae about the birth (this oddly only happens quite late into the pregnancy, for me it was around 24 weeks) I really wanted my own midwife as I'd heard that laboring with a midwife had better outcomes for baby and mommy, and I've delivered enough babies to know that things would be a lot more pleasant if you had a friendly, familiar (professional) face helping you through. 

Problem number 1, Dr Basson does not work with midwives at all, ever, full stop. I was willing to overlook this issue, and as one does with plans, started working on plan B. The plan without a midwife.

Problem 2 arose when I went and visited City Park hospital. The staff were incredible and as I'd worked in their trauma unit, I already felt at home. But the labour ward itself was in a bad state as far as private hospitals go. It was 2 or 4 women sharing a ward, with dirty windows and dodgy 1980's floral curtaining. The labour room was dark, small and scary, the passages were really narrow and there was only one bathroom on the floor. I hope I'm not coming off as a snob, but hospitals are expensive, I didn't wanna feel like I was staying in a cheap hotel during the most important event of my life, not at that price. I also wanted to feel that I could relax in hospital for a day or 2 before entering into the great abyss of mommyhood. Sharing with 3 other women and crying babies is not my idea of relaxation.

I visited Cape Town mediclinic that same afternoon, and in sharp contrast it had all the makings of a good homely hotel, but it also felt a little too homely and I was sceptical about the clinical care. Speaking to Dr Basson later that day, I discovered that the clinical care at mediclinic was indeed not up to scratch and she had had too many bad experiences at that hospital. She refused to deliver my baby there and we made a decision together that I be transferred to Dr Jacky Searle at Vincent Palotti.

Dr Searle was incredible. She saw me quickly, we got along really well and as luck would have it, was happy to work with a midwife. I was over the moon about delivering at Vincent Pallotti as it was almost my second home, having worked in their trauma unit for years, and also because my practice is right next door. 

I really started researching birth options in earnest at this point, having learned my lesson for leaving it to the end. I also knew that my midwife would want to know what my plan was in more detail. 

Having spoken to every mother and pregnant woman who walked into my practice doors while I was pregnant, I knew that most women have epidurals. I also knew that most women are offered epidurals before they've even really felt the pain of labour. What I learnt in medschool was that epidurals increase your chances of needing some sort of assistance in labour eg episiotomies, vacuum extractions, forceps delivery, Caesarian sections... all of which I knew for a fact I did not want, and that like anything, they do carry risk, sometimes with devastating consequences. Of all the female patients I'd spoken to, only 3 had natural births with no epidural or other pain relief... only 3. 

Armed with this knowledge I marched off to meet Sr Ciska at Birth Options in Plumstead. You know when things happen in your life that change your life forever? That's what happened when I met Ciska. She was so wonderful and so calm and so confident that I suddenly felt I could do anything. For the first time in my life, I considered having natural birth without pain relief at all. I say no pain relief because I knew that I didn't want anything that could harm the baby in any way from the start, so medical pain relief was out anyway. Just because I considered it, doesn't mean I believed that it would happen, but I did start to think about how wonderful it would be if I really could labour my child like our mothers and grandmothers did... screaming with all their hearts!

Both Ciska and Jacky recommended I go to Emma Numanoglu's antenatal classes, called Me a Mama in Rondebosch. I hurriedly dragged my hubby off to the first available class and once again felt like everything was going to be different from that moment. I could go on forever about how fantastic these classes were. I mean I thought I knew it all and was just going so my hubby wouldn't be a blithering idiot in the labour ward. Turns out she taught me more useful information about birth than I ever learnt at med school... and my hubby definitely wasn't a blithering idiot, he ended up being completely indispensable!

The thing that Emma said though, that made the greatest impact, was something I really already knew... THE PAIN ENDS! I mean, I know it ends eventually, but it comes in contractions. So each contraction is a tiny little bite sized, manageable fraction of pain. OK that's over simplifying it, but the little detail that I was missing is that you only have to be strong for a minute, then God lets you rest and get your strength back. Granted it gets stronger and closer together as time goes by, but by the time its on top of each other, you're almost ready to push. To give you an idea, contractions can be 20 minutes apart and last 30 seconds at first, increasing to about 60 seconds long and 5 minutes apart in active labour.
 
 I mean that's doable right?

Yea I thought so too, so I started focusing on having a pain killer free birth. What I learned was that women who go to hospital too early have a greater chance of needing intervention... so I planned to go as late as possible. I also learned that the breath is the most important factor in relieving pain... so I learned how to breathe properly in labor. (Funnily enough, and remember this, panting is only effective when you have to hold back the urge to push, the rest of the time deep, slow Yoga breaths really do wonders to make contractions seem shorter and milder.) I learned that warm water has amazing pain relief qualities... so I made sure that Vincent Palotti had a laboring bath. I also let Ciska know that she was not to even mention pain relief to me during birth.

 The next hurdle I wanted to overcome was the dreaded vaginal tear. My big fear was having a third degree tear (that means right through to the bum :( ) and I knew this was one thing I couldn't prepare for... or could I? I discussed my fear with Ciska and she said, "oh yes you can", and lo and behold she pulled out a little torture device called an Epi No, birth trainer. This little device is essentially so you can practice 'giving birth' to an increasingly larger balloon, meant to mimic a baby's head. The balloon is inserted and then pumped up gradually more and more each day till it actually gets to the size of a baby's head (yes you can scream now), and after allowing it to stretch inside you, you then exercise your pelvic floor muscles by pushing it out.

Readers, I'm game for anything, in Survivor I'd be the one eating the snake testicles... but this I could not do. I tried though... twice. It is as painful and uncomfortable as it sounds, and even more embarrassing. I found myself thinking, I'm gonna go through this once with the reward of my baby at the end, why would I wanna put myself through it 20 times before? (with the reward of a big blue balloon no less) I also couldn't go through with asking my husband to assist with the delightful 'perineal massage' suggested in antenatal classes, as attractive as the hairy vagina was in the 1960's diagramatic representation (that's not very, in case you were wondering) So I decided to let this one slide, and leave the laxity of my perineum up to fate.

The next glitch came as I patiently waited for my due date to arrive. The glitch part happened when the day came and went, and I still had no sign of imminent labour. I had many friends and patients who were induced because of going past their due date and I'd seen many of those have to have an epidural because the pain is so much more intense, or worse, move to Caesar because of failure of labour to progress safely. I also feel more than know, that a baby and a mother should be ready to bring that child into the world, and science doesn't have the capabilities to assess that readiness on every level yet. So, knowing that I didn't want to be induced into labour, the passing of my due date came with a bit of anxiety. I spent the last few of my uncomfortable, bloated pregnant days first googling "natural labour inducing methods", and the rest of the time, swimming furiously, eating Basil, getting acupressure massages and swallowing Evening Primrose Oil capsules.(This was the most comprehensive list I found btw - http://wrylilt.hubpages.com/hub/Ways-to-induce-Labour-Naturally) It was somewhere in this time that I also came across some homeopathic aids to labour. I bought the Feel Good Health labour remedies:Birth Drops (to drink during labour to assist the process); Heavenly Labour (a massage oil to encourage contractions and assist in pain control); and BirthBath oil (a bath oil to add to the birth water in first stage, to facilitate labour)

So finally, a week later than expected and the day after spending an entire day in the pool, swimming for my life, I woke up with a suspicious wet spot on the bed...


to be continued...

 

If your birth plan was similar or completely different, or even if you didn't have one, please share your comments for our readers...